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Resident Concealed Weapons Permit

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Resident Concealed Weapons Permit MOUNT DESERT POLICE DEPARTMENT BAR HARBOR POLICE DEPARTMENT James K. Willis, Chief of Police BHPD MDPD 37 Firefly Lane 21 Sea Street, P0 Box 248 Bar Harbor, Maine 04609 NE Harbor, ME 04662 Tel: 207-288-3391 Tel: 207-276-5111 [email protected] [email protected] TO THE RESIDENT APPLICANT: Please review the copy of the booklet “Laws Relating to Permits to Carry Concealed Handguns.”Please complete and return this entire package with the following items: • Application for a Permit to Carry Concealed Handguns, pp. 1-6 • Authority and Authorization to Release Information forms must BOTH be filled out completely by the applicant whether applying for the first time or renewing. Return these forms with the application to the Bar Harbor Police Department. • Fee of $40.00 for NEW applicants: o If your permit expired over 6 months ago, you are considered a NEW applicant and must pay the $40.00 fee (Make check payable to: Town of Bar Harbor) you are also required to submit your supporting documents again: eg. Birth Certificate (BC), Hand Gun Safety Certificate (HGS) • A fee of $20.00 is required if you are a valid RENEWAL applicant (your permit is NOT more than 6 months expired, you have NOT changed your address more than 30 days prior without noti~ing the Issuing Authority); • A fee of $2.00 is required if you are requesting a DUPLICATE permit, a CHANGE OF ADDRESS or CHANGE OF NAME permit; o If you moved over 30 days prior without notifying us, not only are you a NEW applicant, your current permit is invalid you are prohibited from carrying a concealed handgun; • If you hold a State of Maine issued permit from another Issuing Authority in Maine, include a complete copy of that permit with your application. • If you are or were a member of the Armed Forces of the United States of America, a copy of your DD2 14 serves as proof of knowledge of handgun safety. You must have served long enough to complete basic firearms training. You also may NOT have a Dishonorable discharge from the Service. NEW Applicants: A copy of your Birth Certificate (BC) or INS document. NEW Applicants: A copy of a certificate which has been issued within the past 5 years that shows Proof of Knowledge of Handgun Safety (HGS). If you have NOT been issued a permit from the Bar Harbor Police Department in the past, we will need your supporting documents even if you are a valid renewal (you have a current, valid permit issued from another Issuing Authority of Maine). SEND YOUR COMPLETED APPLICATION PACKET TO THE BAR HARBOR POLICE DEPARTMENT AT THE ADDRESS SHOWN ABOVE. MAKE CHECK PAYABLE TO: TOWN OF BAR HARBOR BAR HARBOR POLICE DEPARTMENT FOR OFFICE USE ONLY APPLICATION FOR PERMIT cI~actc#__________ J~ô:~b TO CARRY CONCEALED HANDGUN-. RESIDENT LTCENSE#________________ Z NEW ($4o Qo) RENEW ($20.00) : DUPLICATE ($2.00) DATE:______________ Z CHANGE OF ADDRESS ($2.00): CHANGE OF NAME ($2.00) DATE IF]SSUED: FULL NAME: PRIOR LEGAL NAME(S): ALIASES: BIRTHDATE: EYE COLOR: HEIGHT: FT IN BIRTHPLACE: HAIR COLOR: WEIGHT: CITIZEN: Y N RACE: SEX: M F EMAIL ADDRESS: PHONE NUMBERS CELL: HOME: WORK: LEGAL MAILING ADDRESS: LEGAL PHYSICAL ADDRESS: LIST ALL ADDRESSES YOU HAVE LIVED AT DURING LAST 5 YEARS; INCLUDE MOVE IN AND MOVE OUT DATES; USE ADDITIONAL SHEET OF PAPER IF NEEDED: MO/YR IN - MO/YR OUT PREVIOUS VERSIONS OF THIS FORM ARE OBSOLETE AND SHOULD NOT BE USED AG FORM IR REVISED 8/31/2015 Applicant Initials __________ Page lof 6 LIST OF PREVIOUSLY ISSUED PERMITS TO CARRY CONCEALED HANDGUNS OR OTHER CONCEALED WEAPONS BY ANY ISSUING AUTHORITY IN MAINE OR ANY OTHER JURISDICTION. For each permit previously issued, please identify the issuing authority (e.g. Massachusetts State Police; Portland P.D.; Town of Shapleigh, Selectmen) and the date the permit was issued. LIST OF PREVIOUS REFUSALS TO ISSUE PERMIT TO CARRY CONCEALED HANDGUNS OR OTHER CONCEALED WEAPONS BY ANY ISSUING AUTHORITY IN MAINE OR IN ANY OTHER JURISDICTION. For each refusal of a permit, please identify the agency that refused to issue the permit, and the date of refusal. (Include Explanations) LIST OF PREVIOUS REVOCATIONS OR SUSPENSIONS OF HANDGUNS PERMITS OR PERMITS TO CARRY CONCEALED HANDGUNS OR OTHER CONCEALED WEAPONS BY ANY ISSUING AUTHORITY IN MAINE OR IN ANY OTHER JURISDICTION. For each revocation, please identify the agency or authority that revoked the permit and the date it was revoked or suspended. (Include Explanations) PREVIOUS VERSIONS OFTHIS FORM ARE OBSOLETE AND SHOULD NOT BE USED AG FORM IR REVISED 8/31/2015 Applicant tnitials _________ Page 2of6 CIRCLE APPROPRIATE ANSWER AFTER EACH QUESTION. a. Are you less than 18 years of age? YES NO b. Is there a formal charging instrument now pending against you in this state for a crime under the laws of this state that is punishable by imprisonment for a term of year or more? YES NO c. Is there a formal charging instrument now pending against you in any federal court for a crime under the laws of the United States that is punishable by imprisonment for a term exceeding one year? YES NO d. Is there a formal charging instrument now pending against you in another state for a crime that, under the laws of the that state, is punishable by imprisonent for a term exceeding one year? YES NO e. If your answer to question (d) is “yes”, is that charged crime classified under the laws of that state as a misdemeanor punishable by a term of imprisonment of 2 years or less? YES NO f. Is there a formal charging instrument pending against you in another state for a crime punishable in that state by a term of imprisonment of 2 years or less and classified by that state as a misdemeanor, but that is substantially similar to a crime that under the laws of this State is punishable by imprisonment for a term of one year or more? YES NO g. Is there a formal charging instrument now pending against you under the laws of the United States, this State or any other state or the PassamaquoddY Tribe or Penobscot Nation in a proceeding in which the prosecuting authority has pleaded that you committed the crime with the use of a Handgun against a person or with the use of a dangerous weapon as defined in Title 17-A, M.R.S.A. § 2(9) (A)? YES NO h. Is there a formal charging instrument now pending against you in this or any other jurisdiction for a juvenile offense that, if committed by an adult, would be a crime described in question (b), (c), (d) or (I) and involves bodily injury or threatened bodily injury against another person? YES NO i. Is there a formal charging instrument now pending against you in this or any other jurisdiction for a juvenile offense that, if committed by an adult, would be a crime described in question (g)? YES NO j. Is there a formal charging instrument now pending against you in this or any other jurisdiction for a juvenile offense that, if committed by an adult, would be a crime described in question (b), (c), (d) or (f), but does not involve bodily injury or threatened bodily injury against another person? YES NO k. Have you ever been convicted of committing or found not criminally responsible by reason of insanity or mental disease or defect of committing a crime described in question (b), (c), (I’) or (g)? YES NO I. Have you ever been convicted of committing or found not criminally responsible by reason of insanity or mental disease or defect of committing a crime described in question (d)? YES NO m. If your answer to question (I) is “yes,” was that crime classified under the laws of that state as a misdemeanor punishable by a term of imprisonment of 2 years or less? YES NO PREVIOUS VERSIONS OFTHIS FORM ARE OBSOLETE AND SHOULD NOT BE USED AG FORM IR REVISED 8/31/2015 Applicant Initials Page 3ofG n. Have you ever been adjudicated as having committed a juvenile offense described in question (h) or (i)? YES NO o. Have you ever been adjudicated as having committed a juvenile offense described in question U)? YES NO p. Are you currently subject to an order of a Maine court or an order of a court of the United States or another state, territory, commonwealth or tribe that restrains you from harassing, stalking or threatening your intimate partner, as defined in 18 United States Code, Section 921(a), or a child of your intimate partner, or from engaging in other conduct that would place your intimate partner in reasonable fear of bodily injury to that intimate partner or the child? -- YES NO q. Are you a fugitive from justice? YES NO r. Are you a drug abuser, drug addict or drug dependent person? YES NO s. Do you have a mental disorder that causes you to be potentially dangerous to yourself or others? YES NO t. Have you been adjudicated to be an incapacitated person pursuant to Title 18-A, Article V, Parts 3 and 4, and not had that designation removed by an order under Title 18-A, M.R.S.A. §5-307 (b)? [Termination of incapacity, Probate Code; protection of persons under disability and their property] YES NO u. Have you been dishonorably discharged from the military forces within the past 5 years? YES NO v. Are you an illegal alien? YES NO w.
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